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New Year’s Resolutions – why is it so difficult to succeed?

Come the New Year, come the idea to make some changes; to get fit, to be happier, to drink less – the list goes on.

I am sure it is a well-researched fact that sales of self-help books increase in January, as does gym membership. And yet how often does the resolve dissolve after a month or two and is then not thought about until the following New Year’s Eve.

The paradoxical theory of change

One approach to not succumbing to this familiar pattern can found in gestalt therapies’ paradoxical theory of change. This theory was first described by Arnold Beisser in 1970. Beisser suggests that the more we try to change, the more we stay the same. He says, “Change occurs when one becomes what he is, not when he tries to become what he is not. Change does not take place through a coercive attempt by the individual or by another person to change him, but it does take place if one takes the time and effort to be what he is – to be fully invested in his current positions. By rejecting the role of change agent, we make meaningful and orderly change possible.” (Beisser, 1970).

Beisser is telling us that change is only possible when we fully accept and understand the process and mechanisms involved in desiring a change to take place.

However, when we desperately want a change, it is very difficult to turn and invest in the current position, particularly if it is difficult to understand the rationale of a theory that can sound counter intuitive. It might be useful to take a closer look at how the Paradoxical Theory of Change works in practice. If through an example, the movement of this process becomes clearer, our ability to invest in the current position may become strengthened.

An example of the Paradoxical Theory of Change

So here is a hypothetical example. Tom (who is not based on anyone in particular) wants to lose weight. He has put on weight over Christmas and feels uncomfortable and disgusted with himself. So he starts a diet, joins a gym and plans a rigorous routine. He feels enthusiastic and starts on his new routine. However, a couple of weeks later, he is eating more than ever and not going to the gym.

In terms of the Paradoxical Theory of Change, the reason for this is that here is an internal conflict. He wants to get rid of the “fat” version of himself. This “fat” one represents everything he doesn’t like about himself. If he changes that, he can get rid of those unwelcome feelings. He can change and become a leaner version of himself that he will like.

Fritz Perls, one of the founders of gestalt therapy, said that this conflict was made up of a top dog and an under-dog. In other words, a “shoulder” and a “resister”. The shoulder (or top dog) is saying “I must be lean” and the resister (or under-dog) is saying “I don’t want to stop eating or do exercise – leave me alone!” These two positions are in an intrapsychic war which takes up all his energy. At this point Tom may give up and forget about any desire to change until next the next New Year’s resolution comes around.

If however, he was to work following the Paradoxical Theory of Change, he would investigate further. By investing in the current position, it is likely that he would discover more about each position.

He might find out that he is tired and overworked and eating is providing comfort. He might also unearth harsh internalised messages such as “I must be lean in order to be loved”. These feelings may need to be expressed and understood. This work may also reveal that there are some other changes Tom needs to make first before he can move towards getting fitter and losing weight. For example, getting enough rest, spending time with friends, to name but two.

Choices vs. demands

Investing in these two positions that are at war allows a different kind of internal conversation to emerge and a possible integration of the two positions. This may result in choices rather than demands. With the greater support that this new understanding and integration makes possible, Tom may discover that his relationship to eating and exercise changes, giving space to develop a routine that is not based on a rejection of himself and his needs.

As Beisser says; “change can occur when the patient abandons, at least for the moment, what he would like to become and attempts to be what he is. The premise is that one must stand in one place in order to have firm footing to move and that it is difficult or impossible to move without that footing.”

So maybe this year’s New Year’s Resolution could be being where you are, and that is certainly not as easy as it may sound! Good luck.

 

Brighton and Hove Psychotherapy is a collective of experienced psychotherapists, psychologists and counsellors working with a range of client groups, including fellow therapists and health professionals. If you would like more information, or an informal discussion please get in touch. Online therapy is available.

 

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Psychotherapy supervision

The relationship between a psychotherapist and their supervisor is a very important one. Supervision is a vital place to reflect on clinical dilemmas, talk about professional issues and learn from someone more experienced. It can also be a self-care exercise. It feels good to talk to a trusted colleague about our work in a confidential setting. As I learn and reflect more on psychotherapy supervision, it has made me think about the supervision I’ve received throughout my career so far. During a recent group discussion with other professionals, we asked ourselves, “What constitutes good supervision?”

From my own learning and experience, including trial and error with supervisors who did not meet my needs, I thought about the importance of the following elements in supervision:

  • Education
  • Ethics
  • Political and social awareness
  • Relationship to power and authority
  • Self-awareness
  • Supervisor/therapist compatibility
  • Theoretical and philosophical values
  • Trust

Education

I want to be able to learn from my supervisor and absorb the knowledge of someone more experienced who will positively inform the work I do. Therefore, I have chosen to work with supervisors who keep up to date with the latest research and enjoy both learning and developing others.

The way supervisor and supervisee think together is vital for a productive relationship. This doesn’t mean always agreeing with one another, but having a strong alliance where difficult issues can be discussed and resolved.

Ethics

Ethics and client safety is paramount to the work we do. Therefore, an ethical supervisor needs to be able to explore, question and reflect honestly with their supervisee whilst always holding the client’s wellbeing and safety in mind.

Political and Social Awareness

We all exist in a social, political and cultural context. Therefore, this surely needs to be a part of supervision. Like in psychotherapy, a politically and socially aware therapist and supervisor will think about the place in society of their client and supervisee through their culture, sexuality, gender, age, class, ability and relationship to their identity.

Relationship to Power and Authority

This takes me to the supervisor’s relationship to power and authority and how they use, or potentially abuse, their role. A supervisor needs to hold their authority and personal power in a way that acknowledges the power imbalance in the supervisory relationship, whilst being open to being challenged and learning from others. Granted, this is a fine balance to strike and one which is entirely possible to hold if the supervisor him/herself is willing to have an ongoing enquiring relationship to their power and authority and be honest with themselves in these areas.

Self-awareness

This relates to the point above. For a practitioner to be able to supervise others in an ethical way, they need to practice what they preach. Senior practitioners can fall into the trap of thinking they know it all and don’t need to be professionally supervised or have therapy. In my opinion, this attitude can lead to a fall in professional standards, and even to professional negligence or malpractice.

Supervisor/therapist compatibility

Lack of compatibility between supervisor and therapist can have significant consequences for career development. Often, trainee therapists end up with a supervisor who is allocated to them, rather than actively choosing the right practitioner for them. As a trainee therapist, this experience led me to staying in supervision with an allocated supervisor for way longer than I should have. In the end I left feeling resentful and frustrated with the lack of compatibility between us in theoretical approach and professional direction. My learning had stalled and was hungry for someone that could help me grow professionally. I was lucky to then find the right person from whom I learnt immensely as a professional.

Theoretical and philosophical values

I believe that supervisor and supervisee need to be on the same page on the fundamental basics of what constitutes effective psychotherapy or counselling. Also, on the level of training and skill needed to offer an ethical and professional service which is of sound therapeutic value to the client.

Trust

Arguably, without trust there is no relationship which can withstand the challenges of this key professional alliance. The supervisor’s role is, in my opinion, the most important support system of a clinician. Hence, there needs to be enough trust for the therapist to be open and honest, and feel able to navigate through difficult issues with their supervisor. Both are required to acknowledge and respect that mutual trust is vital for the benefit of all involved: supervisor, supervisee and, ultimately, the client.

Sam Jahara is a UKCP registered psychotherapist, certified transactional analyst and clinical supervisor. She works with clients and supervisees in Hove and Lewes.

Further reading

Clinical Supervision

Self Care 101 for Therapists

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Is starting psychotherapy a good New Year’s Resolution?

Most of us make some sort of New Year’s resolution, whether overtly or covertly.  The new year can feel like an opportunity to put the past behind us and to start afresh.

Whether or not we actively name and own our New Year’s resolutions, most of us can also attest to the best held intentions for change slipping away. There are plenty of good reasons why New Year’s resolutions don’t work. We are often too unspecific in what would constitute change, and it can be hard to make change on our own.

Psychotherapy is about change.  However, the start of all change comes from inside. To make change, we need to understand ourselves and accept why we have made the decisions we have. Nothing is random.

Psychotherapy is first and foremost about learning to have a relationship with ourselves and to learn to hold ourselves in mind, often in ways others failed to do when we were growing up. When we hold ourselves in mind, we can objectively evaluate if something is helpful or in our best interests.

We learn to hold ourselves in mind through others holding us in mind. This is one of the main roles of a psychotherapist. Holding a client in mind is far broader and deeper than simply making notes and remembering what they told us. It is about having a relationship with them and helping them to understand their blind spots, their relational patterns to themselves and to others. Helping them work through this is the therapeutic encounter.

Psychotherapy is often hard. Keeping to a weekly day and time when we meet with our psychotherapist can feel like a slog. Unlike a New Year’s resolution, the process is held relationally. Your psychotherapist makes the time and space available to hold you in mind and expects you to show up for the weekly dialogue. Even if you do not attend, your therapist is there to hold you in mind.

Perhaps the question is not so much whether psychotherapy is a good New Year’s resolution. Rather, it may be whether you are committed to having a deeper and more meaningful relationship with yourself, and through this, learning to hold yourself better in mind. The latter will lead to long-lasting changes on a profound level which may or may not include more frequent trips to the gym!

Happy New Year from all of us at Brighton and Hove Psychotherapy.

Mark Vahrmeyer is a UKCP-registered psychotherapist working in private practice in Hove and Lewes, East Sussex. He is trained in relational psychotherapy and uses an integrative approach of psychodynamic, attachment and body psychotherapy to facilitate change with clients.

Further Reading

New Year Reflections

How psychotherapy works

What is psychotherapy?

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What is Psychotherapy?

In this age of jettisoning the past and continually embracing the new, the answer to the question of how psychotherapy works has remained largely unchanged since the days of Freud.  Modern enquiry and comprehension brings the capacity to understand what happens in the brain as a result of effective analysis, psychotherapy, or indeed, good enough parenting.

To use an analogy, Freud worked out how to bake the cake of psychoanalysis and with it, what ingredients to use.  Modern science has the capacity to empirically prove how those ingredients work through neuroscience research.  In this piece, I shall concern myself solely with the main ingredients of what is needed for effective psychotherapy.  Although they are but two, how they are applied marks the difference between an amateur cook and a master chef.

In 1968, Michael Balint, a psychoanalyst in Britain, wrote the following ‘recipe’ for effective analysis which holds true for counselling and psychotherapy to this day:

“Although, as a rule, it is not stated quite so implicitly, we are compelled to recognise that the two most important factors in psychoanalytic therapy are interpretations and object relationship. It should be borne in mind, however, that with the latter we are on comparatively unsafe grounds because psychoanalytic theory knows much less about it.” (p159, The Basic Fault – Therapeutic Aspects of Regression)

Balint is making two important points in this brief paragraph. Firstly, he gives us the key ingredients of what makes psychotherapy work. Secondly, he tells us that while object relationship is an essential ingredient, in 1968, psychoanalysis lacked an understanding of why that is.

A basic cake ingredient remains the same through the generations. No doubt, there are scientific reasons to explain why the chemical constituents of flour and egg make a good cake. This is also true of Balint’s main ingredients; interpretations and object relationship, or, put more simply, understanding ourselves and the importance of the therapeutic relationship.

Understanding, or, Knowing Thyself

Insight and understanding is a key tool in making changes.  If clients can form a compassionate – and that word is key – understanding of how their past relationships (object relationships) and experiences have shaped them, they can develop the capacity to change.  However, this possibility of change is entirely contingent on the therapeutic relationship they form with their therapist.  Insight alone cannot lead to change. This is the fundamental answer as to why the many shelves of self-help books comprising an ever-increasing proportion of high street booksellers, never really lead to any change in their hopeful authors. Change requires a relationship in which loss can be worked through and trust built in a new way of relating; trust that the other person in the relationship (the psychotherapist) will not let the client down. At least not catastrophically.

Object Relationships

Why can change only take place in the capacity of a relationship?  In the past, I have written blogs about the therapeutic relationship and its importance, as well as on the principles of attachment.  However, to recap, psychotherapy is about re-parenting.  On a fundamental level, it is about helping the client to experience a good enough relationship where they are listened to, cared about and held in mind.  Through this, the client can start to develop their own mind, and over time, hold themselves in mind in ways they have not been able to do in the past.

If the therapeutic relationship is so important, why is it not enough?  It can be argued that affective attunement is about offering interpretation, if interpretation is about helping a client to understand why they feel, think or behave in a certain way. Is this not, after all, what a good enough mothering relationship provides, minute by minute, hour by hour and day by day?

To contradict myself, it is also too simplistic to simply suggest that the object relationship with a psychotherapist is akin to re-parenting. It is far more disappointing and frustrating than that. It is, for the client, a coming to terms with the stark reality that they cannot and will not ever have the mothering they needed for the child they once were. It is the working through of this and then, ultimately, the abandoning of infantile objects – unconscious childhood trauma driven states of mind – for adult objects – conscious adult states of mind that can tolerate the limitations of adult life and adult relationships; a tolerance of pain and abandonment of pleasure.

Mark Vahrmeyer is a UKCP-registered psychotherapist working in private practice in Hove and Lewes, East Sussex. He is trained in relational psychotherapy and uses an integrative approach of psychodynamic, attachment and body psychotherapy to facilitate change with clients.

Further reading on this subject:

How does counselling or psychotherapy work?

What is transference?

Click here to download a PDF version of this post.

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Therapists’ rooms

Andrew Robinson, an MA Photography student from the University of Brighton, recently visited our Hove clinic to photograph our rooms for a project around the therapist’s chair. We are delighted to be able to share some of Andrew’s images on our blog. His artist’s statement can be found below. Andrew can be contacted via baronbouchard@hotmail.com. 

In 1938 Sigmund Freud came to Great Britain, exiled from Nazi Austria. Amongst the possessions rescued from Vienna was his famous couch, which still resides in his home in Hampstead.

In the modern therapist’s room, the décor is bland, but the room is a place of trauma and heightened emotion.

The chairs are a site of trauma, of a fleeting intense ideal relationship that is secure and completely private. The relationship only exists in the space of that room. At the end of each session, a parting occurs that presages the end of the relationship for ever – the end of the therapy. The chairs then stand empty.

Sometimes that relationship is strained, awkward, confused. Sometimes it is concurrent. Sometimes only the client struggles. The only thing that matters in the room is the relationship between the people who use the chairs, in a room that has no other function.

Andrew Robinson

Further reading:

The therapy room

The role of the therapy room in the clinical frame

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Beginning psychotherapy – heading into the forest

Beginning the journey

Starting psychotherapy can be a daunting prospect for anyone. An analogy that is often made is that of starting a journey. What is daunting is that this is a journey into the unknown, akin to the journey into the forest that is so often embarked on in fairy tales. This journey into the unknown must be taken for psychotherapy to take place. And yet, psychotherapy currently exists against the backdrop of a society that demands certainty. With dazzling technology at our fingertips, we demand to know what an experience is like before we have experienced it in order to then agree to experience it. This demand can blunt the excitement of the new, and, indeed, the wonder of the lived experience, but it is what many of us have come to expect.

Support and challenge

Throughout the ages, readers of fairy tales have had the support of the familiar and repetitive structure of the stories to help them journey with the characters into the unknown. On the therapeutic journey, we need to take a step towards what is unknown. However, at times, we also need to lean back and be supported by what is known and stable. The combination of these two aspects allows the therapy to be safe and yet not restrictive, alive and yet not too overwhelming. In gestalt therapy, this is viewed as a combination of support and challenge.

Support and challenge can be thought of as the two wings of a bird. These wings need to be in a perfect balance, otherwise the bird will not fly. And so it is when a parent is with a child learning to walk. The parent cannot learn the walking for the child. Even if they hold the child to keep them steady, at some point, they will have to let go. Without this letting go, the child will never walk on their own. The parent needs to bear witness to the child falling down again and again, offering their presence and a kindly yet watchful eye to prevent their child from walking into a road or over a cliff.

So for the purposes of this blog, support could be the known and challenge could be the unknown. And to complicate matters further, there is the fact that for some people experiencing support from another is both unknown and extremely challenging.

Known and unknown – entering the forest

In my view, people come to therapy because there has been either a holding too tight or a neglect of the watchful eye during some point in their development. These instances can be many and varied in example, but often form the underlying structure of the difficult symptom experienced. What is known is the difficult symptom. What is unknown is what might emerge in the therapeutic space. It is also what is out of the person’s awareness or as the psychoanalysts refer to it, what is unconscious. This could be thought of as the primordial fears located in the forest of the fairy tale. We may be invested in keeping certain experiences, memories or feelings unknown. We may desire to keep these things in the forest. But these things must be faced and experienced, understood and processed if the symptom is to diminish; perhaps not entirely disappear, but diminish all the same.

In conclusion

So what can support entering into the forest? In the world of fairy tales, the happy ending functions as a support for the hero/heroine. In the world of therapy, it is the presence of another person alongside as well as the consistency of the therapeutic process. And, of course, a leap of faith.

Julia Wright is an experienced UKCP-registered psychotherapist working at both our Hove and Lewes practices.

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How does counselling or psychotherapy work?

I have written in depth about the differences in counselling and psychotherapy – the work and the training of the clinician.  So, for the sake of this blog, I will treat the terms as interchangeable, even though they employ vastly differing depths of work and skill.

How does counselling work? This question often comes up when we are contacted by people who know they need some help, but are unclear how “talking to a stranger” can help them.

Irrespective of a therapist’s modality of training (how a therapist works) – fundamentally, the success of the work is dependent on the quality of the therapeutic relationship and on how the therapist works within this relationship. The latter is extremely important and is often overlooked by less qualified therapists. More on this shortly.

What is the Therapeutic Relationship?

A relationship with your counsellor or psychotherapist is a unique relationship. In the early stages, it may feel a little odd. It is a relationship based on clear boundaries. You know when and where you will meet. You know where you will be sitting. You know that you will not go for a coffee with your therapist after the session. It is also a very intimate relationship where you will, in time, risk sharing thoughts, feelings and memories that are painful and difficult. You might not have shared these thoughts with anyone else before. Paradoxically, it is the boundaried nature of the therapeutic relationship that makes intimacy safe and possible, at least, with time.

So talking with a counsellor or psychotherapist is safe?

Yes and no. Safety in the shape of boundaries is important, indeed, it is vital. However, therapy should not be too safe.  For therapy to be effective, it needs to feel safe enough (which is part of building that therapeutic relationship), meaning that the therapist’s role is to  challenge appropriately from within the relationship.

Is it Simply Talking?

It may look like that at first glance, but significantly more is going on.  Therapists listen to the content of what the client brings, but perhaps more importantly they listen for the feelings behind the content. This is what makes therapy an intimate process, as we allow our vulnerability to be seen by another and validated.

Grieving

Talking is a way of giving shape, form and understanding to experiences. Through language, previous unprocessed experiences can be processed. I often think of the example of Eskimos and their 50 words for snow.  Leaving aside whether this is completely accurate, the principle stands; the Inuit people of North America have far more words for the different types of snow than the average British person. These differentiations in the types of snow enable the Inuit people to make sense of their surroundings and navigate safely.

By giving shape and form to our losses through language, we can start to process them and grieve.

Working in the Relationship

Returning to the concept of working in the relationship, this is where the skill of a good counsellor or psychotherapist comes into its own.  It means to form an authentic relationship with the client; to experience our own emotions in relation to the client and pick through what is theirs, what they are evoking in us and what is simply ours.  This is often summed up as working in the transference (see blog on transference).  It is a subtle, complex and ultimately transformative way of working whereby the therapist helps the client give shape, form and language to their losses which are played out in the relationship between the therapist and client: what remains unresolved in us is destined to be repeated.

Mark Vahrmeyer is a UKCP-registered psychotherapist working in private practice in Hove and Lewes, East Sussex. He is trained in relational psychotherapy and uses an integrative approach of psychodynamic, attachment and body psychotherapy to facilitate change with clients.

Click here to listen to our podcast on this post.

Click here to download a PDF version of this post.

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What is transference?

I am sometimes asked, “What is transference?” Some patients are strongly negative towards the idea (of how they understand) the concept. A blog seems like a good opportunity to de-mystify this term and emphasise its importance to psychotherapy and to psychodynamic and psychoanalytic counselling.

Freud Again!

The notion of transference dates back to Freud. He used the term to describe how patients will project, or quite literally, transfer their feelings from a significant childhood relationship onto their psychotherapist.

The notion of transference is not limited to the therapy relationship. It’s something that is happening all the time in our lives, we simply are not aware of it. For instance, we may respond with anger or frustration if we ‘hear’ our partner use a tone of voice or phrase that a parent once used with us. Conversely, we may be drawn to someone because somehow they remind us of a family member with whom we enjoyed a close relationship.

We constantly invent stories about others with whom we interact. Some of these stories may be accurate based on non-verbal cues, but others are examples of transference.

What’s Wrong With That?

The underlying principle of transference is that it is an unconscious process and therefore, we are unaware of it. While we are engaged in unconscious processes, the conscious part of us is always playing ‘catch-up’ by inventing reasons for why we behave in a certain way or for the way we feel about another person.

In the therapeutic relationship, the patient starts to transfer ideas, fantasies, and feelings onto their therapist. This occurs because the patient knows relatively little about the life of their therapist. What is transferred by the patient onto the therapist becomes the basis of the collaboration in understanding the patient’s relational patterns, childhood traumas and unresolved conflict. In essence, transference becomes a window into the patient’s past.

Counter-Transference

Counter-transference is the term used to describe what the therapist feels in relation to their patient. It is the therapist’s part of the entanglement of the relationship. It enables the therapist to become aware of what the patient may be feeling towards them or eliciting in them. Counter-transference shows why it is so essential for psychotherapists to be well trained and to have undergone their own rigorous analysis or psychotherapy. This enables therapists to distinguish which feelings come from their own unconscious process, and which are counter-transferential.

So transference matters?

Transference is the foundation of the work in psychoanalytical psychotherapy where the unconscious forms the basis of understanding a patient’s struggles.

Is transference risky, or something to be scared of?

In a word, no, providing your psychotherapist is experienced enough to work in the transference and to be aware of unconscious processes. A psychotherapy process should never be dangerous, but nor should it be too safe. It is a daring adventure into the unconscious inner world that can be painful and difficult. Ultimately, however, it carries the goal of relieving suffering and trauma. And delivering freedom from the shackles of the past.

In other words

British analyst Harry Guntrip summarised the purpose and role of transference thus:

“Transference analysis is the slow and painful experience of clearing the ground of left-overs of past experience, both in transference and in counter-transference, so that the patient and therapist can meet “mentally face to face” and know that they know each other as two human beings. This is without doubt the most important kind of relationship of which human beings are capable and is not to be confused with erotic “falling in love”.

Mark Vahrmeyer is a UKCP-registered psychotherapist working in private practice in Hove and Lewes, East Sussex.  He is trained in relational psychotherapy and uses an integrative approach of psychodynamic, attachment and body psychotherapy to facilitate change with clients.

Click here to listen to our podcast on this post.

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Existential therapy

What is existential psychotherapy?

Strictly speaking, existential psychotherapy and counselling is more akin to an approach to the therapeutic work (and to life) rather than a type of therapy.  However, this does in no way to minimise the importance and benefits of an existentially orientated psychotherapy.

One way of thinking about existential psychotherapy is to see it as a philosophical stance, rather than a rigid framework within which the clinician works.  As such it rejects the deterministic view of human nature found in more traditional psychoanalysis and the behaviour school approach.  Existential psychotherapy concerns itself with the problems of existing, or living, and sees clients’ suffering as their inability to accept life as it really is, rather than that their symptoms are manifestations of mental illness.

In existential psychotherapy, the clinician works with the client to help them to find purpose and meaning in their lives, and through the therapeutic alliance works with the client to live a more ‘authentic’ life.  In existential therapy, it is through the therapeutic relationship that ‘inauthentic’ ways of being in the world come to light.  Put more simply, it is within the therapy that the client finds safety and trust to explore the myriad of ways that they hide from themselves and others; how they avoid the realities of life. Whilst these realities can be hard to accept, it is only through embracing them that clients can find authentic – meaningful and purposeful – way of living their lives.

And, it is through the courage of accepting life as it is and embracing ones limitations, that many clients find their suffering and symptoms disappear; what in other types of therapy may be termed symptoms, or mental health problems.

Benefits of existential psychotherapy

In the existential approach, both counsellors and psychotherapists seek to come alongside the client as human beings.  What this means is that they seek to understand the client’s subjective experience of the world and their place in it.  If all neuroses and psychoses are fundamentally solutions to the problem of life and how to find meaning, then the dilemma is one faced by us all, the psychotherapist included.

Existential psychotherapy seeks to help clients find more constructive ways of creating meaning and alleviating their suffering.  For example, existential psychotherapy can be particularly useful in helping former addicts construct more meaningful and multi-faceted lives, where they can bear their distress and seek a wider range of healthy relationships and behaviours in lieu of their behaviour or drug of choice.

In the modern world where prescribed meaning is increasingly absent – religion, family, career – the existential approach can be extremely helpful in grounding clients and enabling them to firstly recognise the ordinariness of their humanity – all human beings must find purpose and meaning.  Secondly, the therapeutic relationship can be a vital collaboration helping clients to work out what will enable them to feel fulfilled and that they have meaning.

In essence, existential psychotherapy is about finding meaning in a world increasingly devoid of meaning.  A life lived without substantial meaning causes suffering, often experienced as anxiety and depression.

What happens during existential therapy?

Existential therapy is a collaboration between the therapist and client where the therapist helps the client to explore the meaning and purpose of their life. This may involve examining their values, beliefs and goals as well as their relationships and sense of identity. Existential psychotherapy is premised on an enquiry into what makes your life meaningful.

The first meeting

The purpose of the initial meeting is to determine whether you and your therapist are a good fit for each other. It’s a time to discuss why you’re there, what you hope to gain from the process and your background. It’s also a time for you to ask as many questions as you feel necessary to make your decision to continue. This first meeting is important for your therapist to better understand you so they can tailor their approach to your specific needs.

Confidentiality in existential therapy

Confidentiality is important in any part of therapy. It’s important you feel comfortable sharing personal and often sensitive information with your therapist knowing they will keep this information private. Your therapist will explain their approach to confidentiality and outline what is expected of you and what you can expect from them. In general, everything discussed in your sessions is confidential, unless there are rare instances when there is a need to break confidentiality. For example, if you are at risk to yourself or others.

The frame

The frame in therapy refers to the physical and contractual boundaries that create a safe and structured environment for the therapeutic process. This includes the length, frequency, and overall structure of the sessions and the process. Your therapist will work with you to establish a framework that feels safe and supportive, whilst focused on achieving the goals you have set out in coming to therapy.

Ongoing sessions

Existential therapy can be conducted over a period of weeks, months, or even years depending on the needs of the individual and whether you, as the client, continue to find the work and the process useful. Ongoing sessions are designed to provide ongoing support and guidance as you explore your inner world. Many of our clients, once getting into the flow of therapy, enjoy the intimate relationship and opportunities to make deep changes to their life.

Existential psychotherapy is offered by Mark Vahrmeyer, Dr Simon Cassar, Susanna Petitpierre and David Keighley.

If you are unsure of the type of therapy you need, you can search for a therapist here.

All the content on this page has been reviewed and vetted by Mark Vahrmeyer UKCP Registered Psychotherapist, Supervisor and Co-Founder of Brighton and Hove Psychotherapy. For any questions or more information about the subjects discussed on this page please contact us.


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Learning to be dependent in the pursuit of independence

When learning to be dependent is necessary

‘Dependence’ is a term that can carry negative connotations. To be ‘dependent’ might imply that we are unable to function alone and that we are unable to be the agent of our own life. It can also be interpreted as subscribing to outdated ideologies of male/female gender roles – the belief that women should be dependent, and men independent.

However, as is often the case in psychotherapy, learning to be dependent can be exactly what a person needs to do. As is always the case in psychotherapy, this dependence is with a view to enabling the client to become genuinely independent. In this sense, dependence is, therefore, a paradox.

Pseudo-independence and emotional neglect

I have previously written about the false sense of independence that some people have, which is born out of emotional neglect – a type of pseudo-independence. In a former blog, I referred to Boarding School Syndrome, in which the illusion of privilege masks emotional neglect and serious attachment disruption.

Pseudo-independence is an extreme reaction against dependence rather than true independence. If, as children, clients have been let down emotionally, or worse, neglected, they learn that nobody can be relied upon. It doesn’t matter whether this neglect came from an upbringing in the social care system or from within the gilded prestige of a boarding school education. These individuals might seem very capable and strong. However, this apparent strength is a mask to protect them from connection, relationships and dependence in the ordinary sense of the word.

Beneath the highly developed outer mask (in the case of neglect couched as privilege) lies a fragile interior. These clients crave connection. They want to be seen and validated for who they are and how they feel. But they find this terrifying. So, instead, they will often throw themselves into high-powered jobs, extreme hobbies or anaesthetise their inner voice with fine wine or expensive drugs.

In the case of someone who has experienced a more outwardly evident neglectful childhood (such as being raised in the social care system) the exterior shell of pseudo-independence is generally less polished and socially acceptable. Instead, their pseudo-independence may be shown through a turning away from society in the form of criminality and a “don’t mess with me” exterior.

How does learning to be dependent lead to healthy independence?

Well, psychotherapy is about learning to have a relationship with both our therapist and with ourselves. It is a process of giving voice to parts of ourselves that we have had to repress, split off or even kill off to survive. It is a relationship in which, week after week, the client learns to be seen and heard, to be accepted and validated. Little by little, if the client allows themselves to really feel seen and heard, and believes it, then it must mean that the other person in the room matters to them. Thus, it is through the psychotherapist mattering to the client that they can finally learn to rely on another emotionally.  Then, a collaboration can begin, with the psychotherapist coming alongside the client to help them make sense of their world.

In every psychotherapeutic relationship, the end is always in sight. It may be a very distant sense of an ending on the horizon, which may be many years away. Nonetheless, it is there. Therefore, the willingness of the client to allow the psychotherapist to matter to them, though this relationship will, one day, come to an end, is courageous. The process of becoming dependent and then becoming independent marks a shift in the relational quality of the client. If they can do this with a psychotherapist, maybe they can allow someone else to matter to them in an ordinary way.

Through learning ordinary dependence, which they never learned in the first place, clients can learn to navigate the ordinary ebb and flow of relationships. They will then discover that dependence on another is not terrifying, after all.  Even when we eventually have to say goodbye.

Mark Vahrmeyer is a UKCP-registered psychotherapist working in private practice in Hove and Lewes, East Sussex.  He is trained in relational psychotherapy and uses an integrative approach of psychodynamic, attachment and body psychotherapy to facilitate change with clients.

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Boarding School Syndrome

The term ‘Boarding School Syndrome’ is one that was brought to public consciousness by Jungian analyst Professor Joy Schaverian around a decade ago. Since then, it has gained significant traction as a model for explaining the often seen experiences and symptoms of adults who were sent away to boarding school as children. Specifically, it is a term used to explain and understand the experience of a child who loses the consistency of their primary attachment figures which constitutes a significant trauma that can shape this child’s life throughout adulthood.

Like all mental health conditions, with the exception of a tiny minority, such as schizophrenia, boarding school syndrome (BSS) refers to a cluster of symptoms. When enough people present with similar clusters of experiences, behaviours or traits, and there is a clear correlation in their experiences, then a diagnostic category can be applied.  Officially, this is not yet the case with BSS, although more and more analysts and psychotherapists (as well as journalists) are using the term. Irrespective of whether the term has been formalised as a distinct diagnostic category, what is clear is the trauma that is frequently caused to children as a result of being sent to boarding school and how this impacts on their ability to form attachments as adults – intimate and connected relationships.

What is Boarding School Syndrome and why does it matter?

Psychotherapy is about helping people to grow a mind and better relate to themselves and those around them.  In order to do this, the clinician will often work with the client’s past experiences, either directly through dialogue, or in the relationship between the client and themselves.  The latter certainly constitutes the ‘relational approach’ which has been evidenced to be highly effective, irrespective of the underlying ‘approach’ to psychotherapy.

Schaverian (and others) suggest that BSS can be identified through disrupted relationship patterns, which with adults are generally found in romantic relationships. One of the characteristics of BSS is that what appears to be a strong sense of independence in the adult proves to be, in fact, a shell or mask, covering emotional vulnerability, depression, anger management problems and in more serious cases, substance misuse or abuse problems.

BSS affects both genders. However, as statistically, boys are sent away to boarding schools in higher numbers than girls, boys and thus men are disproportionately affected.  Add the social expectations on male middle-class and upper-middle class former boarders to adopt a ‘stiff-upper lip’ and the problems they face can become further entrenched and emphasised.

In my experience, former boarders will only present for psychotherapy once they hit a wall. This generally happens when addictive behaviours get out of control or when significant relationships fail.  Once the veneer of privilege and entitlement has been stripped away, the presentation of symptoms is akin to children who have been taken into care and raised institutionally. This results in a catastrophic attachment trauma that makes any form of genuine, close, intimate relationship extremely difficult.

All of the above would matter little, at least from the perspective of the individual in question, if they were to grow up comfortably inhabiting their own skin and needing a close relationships. Human beings are born into and shaped by relationship. We are relational to the core and this cannot be bypassed.

Boarding schools espouse entitlement, (pseudo)-independence and academic rigour. Once a child has been abandoned by his or her parents to this system, the best they can expect to develop is a ‘more-or-less’ robust shell that reflects back to the world the message that they are perfectly fine.  Deep down, they simply are not.

Neglect breeds a false sense of independence irrespective of financial privilege. Whether a child is abandoned to the social care system as a result of an outwardly chaotic family life, or the abandonment is couched in the traditions of boarding school, the attachment disruption and damage remains the same. The result is a false self-reliance with a deep wariness of their own vulnerability and a fear of relationships.  At least children who survived social care have a place to locate their problems – the neglect and abandonment is clearly visible and readily acknowledged by society.

There is no doubt that emotional cruelty has an enormous greatest impact on the developing mind.  And a mind is what we use to understand ourselves – our emotional world and our vulnerability. We also use it to understand the mind of others. Without a developed mind, we may be left adrift in a flood of emotion, which is more often seen with children who have come through the social care system. Alternatively, we become rigid and emotionally stunted, incapable of connection, which is conversely what we see with adult survivors of boarding school.

How to treat Boarding School Syndrome

As I have already suggested, the defence from emotional neglect is the development of a false and rigid sense of independence. This is established by having no attachment figure to soothe them and help them make sense of their inner and outer emotional world. The vulnerable child is still there, but many former boarders will deny its existence, mirroring the attitude of their caregivers. Alternatively, they may treat their vulnerability with disdain, saying things like, “I just need to pull myself together”, “All this wallowing is a waste of time”, and “I am sure you have more deserving patients to see, I really am fine.”

The work of the therapist, like any we do, is in establishing a close, supportive relationship with the patient. This enables them to start to make some tentative contact with his or her vulnerability.

Helping these patients imagine that they experienced neglect (and at times, abuse) can be an enormous piece of the work. For the patient this is hard to do, as it relies on a complete dismantling of a belief system – in their parents, in their privilege, in the institution, and lastly, in their false self.

Despite what former boarders have been taught, finding their way out of their suffering is not something they can do alone or with the help of a book. It relies on the very thing they find hardest; establishing a secure attachment with their psychotherapist.

Mark Vahrmeyer is a UKCP Registered psychotherapist working in private practice in Hove and Lewes, East Sussex.  He is trained in relational psychotherapy and uses an integrative approach of psychodynamic, attachment and body psychotherapy to facilitate change with clients.

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What is psychotherapy?

Freud once described psychotherapy as the “impossible profession.” To those who have not experienced it, psychotherapy can sound like a curious, mysterious, complex or even frightening endeavour.

Using brief and simplistic explanations such as “talking to someone about your problems” to describe psychotherapy does not do it justice. At its best, psychotherapy is a process of looking at all aspects of an individual’s life in its depth and entirety.

What makes a person who they are?

Good psychotherapists are curious about what makes a person who they are, which begins with child development and the formation of personality structures and an individual’s past history of attachment to significant others and transgenerational influences. Additionally, psychotherapists take into account the historical, cultural, social and political influences in an individual’s life. These can include, for example, gender, age, disability, sexuality, cultural norms, their present situation and resources. All of these elements have an impact on how someone both views and processes the issues they bring to therapy.

Finally, much of what is communicated in the therapy room is communicated non-verbally, through facial expressions, body language and tone of voice. This isn’t to say that we, as therapists, scrutinise every detail of how someone presents. It is more about being genuinely curious about who the individual sitting in front of us is, and how they interact with those around them, so that they themselves begin sharing in this curiosity.

How does this lead to change?

Profound change in psychotherapy happens at different levels. At one level, it’s vital that we begin talking about what is troubling us with a curious and understanding other. This reduces isolation and helps us feel heard and validated. It is common for some of the symptoms to begin subsiding at this stage, and to experience a sense of relief. Another common response is for thoughts and feelings to surface more frequently, and this can lead to discomfort in the short term.

At this point, it is important to begin making sense of what we are experiencing. While it feels good to be heard, it is also necessary to skilfully sort through the chaos and uncertainty that can be generated by unprocessed feelings.

Alongside this, we will assess how past and present experiences are linked. For instance, does this situation bring up familiar feelings from the past? In dealing with this situation, what resources are available to you and what beliefs and values are hindering you? Where do these unhelpful influences come from? Throughout psychotherapy, we look at both conscious and unconscious influences in a person’s life. Some of the ways to explore those are through dialogue, associations, insight and dreams.

Next, we explore how to separate internalised unhelpful beliefs from current reality. Here, we draw on your internal resources, exploring the patterns repeat themselves in your life, and how to create a different way of being in the world. This process sounds more simplistic than it actually is, as some of our ways of being in the world are deeply ingrained and take time to shift. Plus, some are survival strategies which we have developed very early on and served us in getting through life, for better or worse.

Psychotherapy is a long-term endeavour because human beings are rich with complexity. This complexity can take time to unravel and transform. For long-term, sustainable change, there are no short cuts and quick fixes.

This just a taste of what psychotherapy can be. However, therapy is always led by what the individual (or group, family or couple) presents, and what they want to achieve. Getting there is a joint piece of work grounded in a solid working alliance between client and therapist.

If you are curious to find out more about how psychotherapy can be helpful to you, please get in touch with us at Brighton and Hove Psychotherapy.

Sam Jahara is a UKCP Registered Psychotherapist and Certified Transactional Analyst with a special interest in cross-cultural and intergenerational influences.

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Psychotherapy for Social Change

Like many of us, I have been emotionally moved and disturbed by recent political events. Concerns over the choice of US president, the rise of the far right in Europe and Brexit have been driving many of us towards social and political initiatives.

I always believed that our work as therapists could make a real difference in people’s lives and that we could change the world one person at a time. The work of raising awareness, reducing psychological pain, educating and facilitating growth, empowering and encouraging people to live more authentic lives – all have an impact not only in an individual’s life, but also in their relationship with others, beginning in their immediate family and spreading to their community and society as a whole.

However, in turbulent times like this, my work within the confines of the consulting room does not feel like enough. The demonstrations on 21st January moved and inspired me to become even more involved in social change. The personal is the political. We all exist in a social, political and historical context and bring this with us into the therapy room. Whatever my part is in society, I hope I can continue to contribute in whichever small way by joining forces with a larger collective of like-minded individuals. May we as a society move more towards values that support fairness, equality, and better relationships between people, nations and the environment.

I hope this isn’t a utopic hope for the world, which denies the shadow aspects of human beings. In the therapy room, as in life, the personal is the political and I will continue to hold the values dear to me both within and outside of these four walls.

Sam Jahara is a UKCP registered psychotherapist and relational transactional analyst.

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What is narcissism?

Narcissism is a Freudian term that has become perhaps more ubiquitous in the social lexicon than any other derived from psychoanalysis.

It is a term that seems to define a generation in the eyes of the media – the Millennials, and one that we use disparagingly to describe celebrities before following them via social media, emulating them or electing them to the highest public office.

Narcissism in psychotherapy

In psychotherapy, narcissism is on a continuum from healthy to pathological. For example, it is entirely possible for a client or patient to lack enough healthy narcissism, in which case, the work is to strengthen their ego accordingly.

The sort of folk who get labelled as ‘narcissists’ – those who crave celebrity status, fame and live up to legend in seeking their reflection in the mirror that is society – rarely presents themselves for therapy. After all, why would they? They don’t have a problem – the problem is everyone else!

When we psychotherapists talk about narcissism and narcissistic defences and structures, it is rarely these people we are referring to. So how can we better understand narcissism as it presents in psychotherapy treatment?

What causes unhealthy narcissism?

Unhealthy narcissism is a defence.  Generally, it comes about through the young infant learning through relational patterns with his or her caregivers that he or she cannot rely on them, leading to a ‘turning away’. This turning away marks the beginning of a defensive structure built around self-sufficiency. However, this is not a self-sufficiency born out of healthy confidence, but one born out of emotional neglect.

Narcissistic structures are often well hidden in clients and patients and difficult to treat. Narcissistic patients and clients tend to treat all relationships, the therapeutic one included, as things that are there to be used and thus discarded when no longer of use. Relationships (in the truest sense of the word) are threatening at a core level to people who rely on narcissistic defences, as any true relating will open them up to a whole host of unbearable feelings and mental pain. The latter lies at the crux of the function of the narcissistic defence; the inability to cope with, endure and make sense of mental pain.

Is working with clients and patients exhibiting narcissistic defences a lost cause? Not if they willingly enter the therapy room and not if they are able to think about their vulnerable side and how they needed to develop a disdain for this part of themselves in order to survive. Without a doubt though, it will be a lively journey, because as the charming, likeable and self-sufficient façade starts to crack, rage, envy and mental pain will emerge and present themselves in the therapeutic relationship. This is often where the therapy can end, as the therapist is unable or unwilling to engage with the enactments that invariably will play out. If, however, these can be worked through, then there is genuine hope.

Mark Vahrmeyer is a UKCP Registered psychotherapist working in private practice in Hove and Lewes, East Sussex.  He is trained in relational psychotherapy and uses an integrative approach of psychodynamic, attachment and body psychotherapy to facilitate change with clients.

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Relational Therapy – a view

There are a number of core concepts in the Transactional Analysis model, which provide a framework and map for understanding our internal emotional landscapes and structures. The concept of “script” suggests that people will often make decisions about themselves and draw conclusions about life from a very young age. Such decisions are made out of conscious awareness, and at the time, they constitute the best option for survival in a world that for myriad reasons, social and environmental, may be frightening, incomprehensible or even life-threatening. A Transactional Analysis approach will invite curiosity about the origin of our script decisions as well as exploration and recognition of how we may maintain and live these (outdated) decisions in our current lives.

No one is an expert on life, and no psychological theory or method holds the monopoly on insight, wisdom or cure. When I first meet a client(s), I am interested in engaging with a whole person and not just the problem they may bring. Each therapeutic encounter is different, since each of us has our unique experience of being a person in the world. Working from a relational perspective, I offer a willingness to engage in a process with my client(s) rather than a promise of certain knowledge. A relational approach is paced and reflective. It does not rush towards interpretation or refrain from appropriate challenge. It involves elements of risk, including that of knowing and not knowing. When we believe we know ourselves (and for that matter another) we perhaps take ourselves for granted, assume our identities as fixed and neglect or foreclose on our greater depths and potentials. Therapy can offer an opportunity for us to be curious about ourselves and to track, understand and challenge our assumptions both about others and ourselves.

I am always interested in the (often) impoverished stories that people tell themselves about the world and the enduring and sometimes debilitating impact that they may confer, physically, intellectually, emotionally, spiritually and relationally. In the speaking of and the listening to these stories it is possible that new stories may begin to be imagined. The therapeutic endeavour will be in part to hold a space in which we may tell, retell, de- and reconstruct and constitute the stories of our selves, such that we might understand more profoundly our appetite (or lack of it) for life.

Uncertainty is an inevitable part of being alive. Perhaps the only real certainty is that we will, one day, die. We are all subject to the urgencies and vulnerabilities of our bodies and our histories are written deep within its archaeology. Our bodies have much to tell us of our selves beyond logic, reason or words. A relational therapy is sensitive to the sometimes inarticulate speech of our more visceral selves, revealed at once in a movement or gesture, a tone of voice or rhythm of speech, a word, a silence. It is in the simple (and complex) practice of listening that I may begin to understand how experience has informed and shaped an individual’s sense of self. The relational practitioner is never a neutral observer but rather an active participant in the therapeutic process, always sensitive to news from within herself about what s/he is thinking and feeling and what this might mean for a client.

I believe that poetry, literature and art have much to tell us about the complexity of human existence and consistently seek to resource myself from these worlds. Sometimes we find ourselves moved to tears of joy or sorrow by the power of musical phrase or lyric, disarmed despite ourselves, absorbed in the experiencing of it, feeling at once known, understood, connected and transcendent. It is this capacity to experience, how we sustain and sabotage it, to enlivening or deadening effect that is of great interest to me and describes something of my own curiosity about the therapeutic endeavour. The language of therapy is at once pragmatic and practical, poetic and evocative, always unique to the individuals involved.

Gerry Gilmartin is is an accredited, registered and experienced psychotherapeutic counsellor who is available at our Hove practice.

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